What is Strep A and what are the symptoms?

Four school children have died of a bacterial infection after cases in England and Wales in the last three weeks.

The pupils caught the rare invasive group A streptococcal infection (iGAS), the UK Health Security Agency (UKHSA) said.

Bacteria called group A Streptococcus can cause scarlet fever - these bacteria are also the cause of strep throat.

Scarlet fever, a disease often associated with the Victorian era, has seen a resurgence again in the UK in recent years.

The number of cases in England hit a 50-year high in 2016 – when some 17,000 infections were reported – and continued to rise in each of the following years, government figures showed in 2020.

The UK Health and Security Agency (UKHSA) has been monitoring infection rates in northwest England.

This follows a number of outbreaks in schools in Lancashire and Greater Manchester, and health officials have advised parents to look out for symptoms in their children.

Is scarlet fever serious?

While scarlet fever was among the leading causes of death in the 19th century, it is now typically a mild illness.

It affects mostly young children, and can now be easily treated with antibiotics.

However, in rare cases, it can cause complications – ranging from ear infections, to pneumonia, meningitis and rheumatic fever.

Is it contagious and how does it spread?

According to the NHS, scarlet fever is “very infectious and can easily spread to other people”.

It is caused by a bacteria called group A Streptococcus, which are commonly found in the nose and throat and also cause infections such as impetigo and strep throat.

It usually takes two to five days for someone exposed to the bacteria to become unwell with scarlet fever.

It is transmitted via airborne respiratory droplets, which can be spread by coughing and sneezing, however, people can also become infected through direct contact with the mucus, saliva or skin of an infected person.

It can also be caught by sharing contaminated towels, baths, clothes or bed linen.

What are the symptoms?

The illness typically begins with flu-like symptoms, which can include a high temperature, headache, sore throat, flushed cheeks, and swollen neck glands.

Early on in the illness, the bacteria can cause a whitish coating to appear on the tongue, which eventually peels, leaving the tongue red, swollen and covered in bumps – also known as “strawberry tongue”.

Some 12 to 48 hours after the initial scarlet fever symptoms, a characteristic pinkish rash then usually appears on the body.

According to the NHS, a scarlet fever rash looks like small, raised bumps and makes the patient’s skin feel rough like sandpaper. The rash starts on the chest and stomach before spreading.

How do you treat it and stop it from spreading?

While most cases of scarlet fever clear up after about a week without treatment, a course of antibiotics are recommended – speeding up recovery time and lowering the risk of complications, according to NHS Scotland.

The fever typically improves within 24 hours of starting antibiotics – usually penicillin or amoxicillin tablets – with the other symptoms disappearing within a few days.

You can relieve some of the symptoms of scarlet fever by drinking cool fluids, taking painkillers such as paracetamol to reduce a high temperature, and using calamine lotion or antihistamine tablets to ease itching, the NHS website says.

A person infected with scarlet fever can spread the illness up to six days prior to symptoms. While people typically remain infectious until 24 hours after a first dose of antibiotics, those who do not to take them typically remain infectious for two to three weeks after the onset of symptoms.

In order to limit the spread of scarlet fever, people are advised to practice good hygiene by washing hands with warm water and soap, covering the nose and mouth when coughing or sneezing, and not sharing drinking glasses or utensils.

Following one of the recent outbreaks, Greater Manchester’s lead director of public health Professor Kate Ardern told the Manchester Evening News: “It’s really important we do try and break the rate of transmission of scarlet fever.

“It sounds like a very old-fashioned disease, which it is, but it’s back on the rise again and we do need to try and contain it.”